Provider Demographics
NPI:1447486626
Name:MILLER, KELLY A (DDS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W 6TH ST APT F9
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4321
Mailing Address - Country:US
Mailing Address - Phone:785-550-6355
Mailing Address - Fax:
Practice Address - Street 1:545 COLUMBIA DR STE 1003
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2363
Practice Address - Country:US
Practice Address - Phone:785-841-4840
Practice Address - Fax:785-841-5750
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist